Anxin Wang
Ticagrelor-Aspirin versus Clopidogrel-Aspirin among CYP2C19 Loss-of-Function Carriers with Minor Stroke or TIA in Relation to Renal Function: A Post Hoc Analysis of CHANCE-2 Trial
Wang, Anxin; Wang, Yongjun; Xie, Xuewei; Tian, Xue; Claiborne Johnston, S.; Li, Hao; Bath, Philip M.; Zuo, Yingting; Jing, Jing; Lin, Jinxi; Wang, Yilong; Zhao, Xingquan; Li, Zixiao; Jiang, Yong; Liu, Liping; Meng, Xia; Wang, Yongjun
Authors
Yongjun Wang
Xuewei Xie
Xue Tian
S. Claiborne Johnston
Hao Li
Professor PHILIP BATH philip.bath@nottingham.ac.uk
STROKE ASSOCIATION PROFESSOR OF STROKE MEDICINE
Yingting Zuo
Jing Jing
Jinxi Lin
Yilong Wang
Xingquan Zhao
Zixiao Li
Yong Jiang
Liping Liu
Xia Meng
Yongjun Wang
Abstract
Background: Evidence on the risk-benefit ratio of dual antiplatelet therapies among stroke patients with impaired renal function is limited and inconsistent.
Objective: To investigate the effect of renal function on the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin treatment.
Design: Post hoc analysis of a multicenter, randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov: NCT04078737).
Setting: 202 centers in China.
Patients: CYP2C19 loss-of-function allele carriers with minor stroke or transient ischemic attack.
Intervention: Ticagrelor-aspirin and clopidogrel-aspirin.
Measurements: Renal function was evaluated by estimated glomerular filtration rate (eGFR) levels. The primary efficacy and safety outcomes were recurrent stroke and severe or moderate bleeding within 90 days, respectively.
Results: Among 6,378 patients, 4,050 (63.5%) patients had normal (eGFR≥90 mL/min/1.73m2), 2,010 (31.5%) patients had mildly decreased (eGFR 60-89 mL/min/1.73m2), and 318 (5.0%) patients had moderately to severely decreased (eGFR<60 mL/min/1.73m2) renal function. The corresponding differences in recurrent stroke between ticagrelor-aspirin and clopidogrel-aspirin for normal, mildly decreased and moderately to severely decreased renal function was -2.8 percentage point (95% CI, -4.4 to -1.3 percentage point) (hazard ratio [HR], 0.63 [CI, 0.49 to 0.81]), -0.2 percentage point (CI, -2.4 to 2.0 percentage point) (HR, 0.98 [CI, 0.69 to 1.39]), and 3.7 percentage point (CI, -2.3 to 10.1 percentage point) (HR, 1.31 [CI, 0.48 to 3.55]) respectively. Rates of severe or moderate bleeding did not substantially differ by treatment assignments across eGFR categories.
Limitation: Renal function was only evaluated by using eGFR and the proportion of patients with severely decreased renal function was low.
Conclusion: Patients with normal, rather than impaired renal function, received greater benefit from ticagrelor-aspirin versus clopidogrel-aspirin.
Citation
Wang, A., Wang, Y., Xie, X., Tian, X., Claiborne Johnston, S., Li, H., Bath, P. M., Zuo, Y., Jing, J., Lin, J., Wang, Y., Zhao, X., Li, Z., Jiang, Y., Liu, L., Meng, X., & Wang, Y. (2022). Ticagrelor-Aspirin versus Clopidogrel-Aspirin among CYP2C19 Loss-of-Function Carriers with Minor Stroke or TIA in Relation to Renal Function: A Post Hoc Analysis of CHANCE-2 Trial. Annals of Internal Medicine, 175(11), 1534-1542. https://doi.org/10.7326/M22-1667
Journal Article Type | Article |
---|---|
Acceptance Date | Sep 18, 2022 |
Online Publication Date | Nov 1, 2022 |
Publication Date | Nov 1, 2022 |
Deposit Date | Sep 21, 2022 |
Publicly Available Date | May 2, 2023 |
Journal | Annals of Internal Medicine |
Print ISSN | 0003-4819 |
Electronic ISSN | 1539-3704 |
Publisher | American College of Physicians |
Peer Reviewed | Peer Reviewed |
Volume | 175 |
Issue | 11 |
Pages | 1534-1542 |
DOI | https://doi.org/10.7326/M22-1667 |
Keywords | Alleles; Antiplatelet therapy; Estimated glomerular filtration rate; Hemorrhage; Ischemic stroke; Myocardial infarction; Renal analysis; Safety; Stroke; Transient ischemic attacks |
Public URL | https://nottingham-repository.worktribe.com/output/11466600 |
Publisher URL | https://www.acpjournals.org/doi/10.7326/M22-1667 |
Files
Manuscript
(342 Kb)
PDF
You might also like
Downloadable Citations
About Repository@Nottingham
Administrator e-mail: discovery-access-systems@nottingham.ac.uk
This application uses the following open-source libraries:
SheetJS Community Edition
Apache License Version 2.0 (http://www.apache.org/licenses/)
PDF.js
Apache License Version 2.0 (http://www.apache.org/licenses/)
Font Awesome
SIL OFL 1.1 (http://scripts.sil.org/OFL)
MIT License (http://opensource.org/licenses/mit-license.html)
CC BY 3.0 ( http://creativecommons.org/licenses/by/3.0/)
Powered by Worktribe © 2025
Advanced Search